右美托咪定联合枸橼酸舒芬太尼对重症肺炎呼吸衰竭需要机械通气患者预后的影响
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摘要
目的:探讨右美托咪定联合枸橼酸舒芬太尼对重症肺炎呼吸衰竭需要机械通气患者预后的影响。方法:选取2014年7月-2016年6月本院收治的重症肺炎合并呼吸衰竭拟行机械通气治疗患者70例,按信封法分为联合组(n=35)和对照组(n=35)。对照组行机械通气+右美托咪定治疗,联合组行机械通气+右美托咪定+枸橼酸舒芬太尼治疗。比较两组Ramsay镇静评分、VAS评分、血流动力学指标、肺功能指标、血清应激反应指标水平、不良反应发生率和住院期间死亡率等。结果:与用药前比较,两组用药24 h和拔管后的SpO_2、OI、PaO_2均较高,同期VAS评分、HR、MAP、PaCO_2及血清IL-6、TNF-α和MDA水平则均降低(P<0.05)。与对照组比较,联合组用药24 h和拔管后的Ramsay镇静评分为2～3分患者比例、OI和PaO_2均较高,同期VAS评分、PaCO_2及血清IL-6、TNF-α和MDA水平则均降低(P<0.05)。联合组住院期间存活率高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:右美托咪定联合枸橼酸舒芬太尼应用于重症肺炎呼吸衰竭需要机械通气患者的镇静镇痛效果和预后较佳,可行性和安全性良好。
Objective:To investigate the effects of Dexmedetomidine combined with Citrate Sufentanil on the prognosis of patients with severe pneumonia and respiratory failure requiring mechanical ventilation. Method:From July 2014 to June 2016,70 patients with severe pneumonia complicated with respiratory failure who were treated with mechanical ventilation were selected,they were divided into the combined group(n=35) and the control group(n=35) according to the envelope method.The control group underwent mechanical ventilation+Dexmedetomidine treatment,the combined group had mechanical ventilation+Dexmedetomidine+Citra te Sufentanil treatment.Ramsay sedation score,VAS score,hemodynamics indexes,pulmonary function indexes and stress reaction indexes,adverse reaction rate and hospital mortality of two groups were measured and compared.Result:Compared with before treatment,SpO_2,OI and PaO_2 were higher in both groups 24 h after treatment and after extubation,while VAS score,HR,MAP,PaCO_2 and serum IL-6,TNF-α and MDA levels were decreased in the same period(P<0.05).Compared with the control group,patients in the combined group 24 h after treatment and after extubation,the Ramsay sedative score of 2-3 points,OI and PaO_2 all more higher,while the VAS score,PaCO_2 and serum IL-6,TNF-αand MDA all decreased during the same period(P<0.05).Survival rate during hospitalization of the combined group was higher than that of the control group(P<0.05).Adverse reactions rate of the combined group and control group had no significant difference(P>0.05).Conclusion:Dexmedetomidine combined with Citrate Sufentanil used in patients with severe pneumonia and respiratory failure requiring mechanical ventilation can gain good sedative and analgesic effect and prognosis,it had good feasibility and safety.
Objective:To investigate the effects of Dexmedetomidine combined with Citrate Sufentanil on the prognosis of patients with severe pneumonia and respiratory failure requiring mechanical ventilation. Method:From July 2014 to June 2016,70 patients with severe pneumonia complicated with respiratory failure who were treated with mechanical ventilation were selected,they were divided into the combined group(n=35) and the control group(n=35) according to the envelope method.The control group underwent mechanical ventilation+Dexmedetomidine treatment,the combined group had mechanical ventilation+Dexmedetomidine+Citra te Sufentanil treatment.Ramsay sedation score,VAS score,hemodynamics indexes,pulmonary function indexes and stress reaction indexes,adverse reaction rate and hospital mortality of two groups were measured and compared.Result:Compared with before treatment,SpO_2,OI and PaO_2 were higher in both groups 24 h after treatment and after extubation,while VAS score,HR,MAP,PaCO_2 and serum IL-6,TNF-α and MDA levels were decreased in the same period(P<0.05).Compared with the control group,patients in the combined group 24 h after treatment and after extubation,the Ramsay sedative score of 2-3 points,OI and PaO_2 all more higher,while the VAS score,PaCO_2 and serum IL-6,TNF-αand MDA all decreased during the same period(P<0.05).Survival rate during hospitalization of the combined group was higher than that of the control group(P<0.05).Adverse reactions rate of the combined group and control group had no significant difference(P>0.05).Conclusion:Dexmedetomidine combined with Citrate Sufentanil used in patients with severe pneumonia and respiratory failure requiring mechanical ventilation can gain good sedative and analgesic effect and prognosis,it had good feasibility and safety.
引文
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[13]钟小东,陈学清,王晨,等.右美托咪啶联合舒芬太尼在ICU慢性阻塞性肺疾病急性加重期患者有创机械通气中的应用[J].中华全科医学,2015,13(5):766-768.
[14]黎祖荣,聂静,董静,等.咪达唑仑联合舒芬太尼在呼吸衰竭机械通气患者中的应用[J].现代医药卫生,2013,29(6):836-837.
[15]吴捷,张建凤,封海彬,等.芬太尼、舒芬太尼、瑞芬太尼联合右美托咪定在机械通气患者中应用的比较[J].医学理论与实践,2013,26(22):2948-2950.
[16]谭明华,黄燕.舒芬太尼联合右美托咪定在ICU机械通气患者中的临床应用价值[J/OL].中国医学前沿杂志(电子版),2016,8(1):69-72.
[2]莫必华,刘艳秀,甘国能,等.小潮气量机械通气治疗老年重症肺炎呼吸衰竭对动脉血气及预后的影响[J].国际老年医学杂志,2015,36(6):249-251,273.
[3]Tsuruta R,Oda Y,Shintani A,et al.Delirium and coma evaluated in mechanically ventilated patients in the intensive care unit in Japan:a multi-institutional prospective observational study[J].J Crit Care,2014,29(3):472.e1-5.
[4]袁广胜.序贯机械通气治疗重症肺炎患者呼吸衰竭的疗效观察[J].临床研究,2016,24(10):102-103.
[5]黎昌,周立新,方滨,等.机械通气患者靶控输注舒芬太尼和芬太尼的血流动力学比较研究[J/OL].中华损伤与修复杂志(电子版),2014,9(4):35-38.
[6]杨明全,周洁,曹建伟,等.ICU机械通气患者右美托咪定镇静的安全性评价[J].中华危重病急救医学,2016,28(9):839-844.
[7]林建良,郑辉才.无创正压机械通气辅助治疗重症肺炎合并呼吸衰竭效果分析[J].医学综述,2016,22(3):606-608.
[8]王贞,王斌.重症肺炎并呼吸衰竭患儿早期给予CPAP对血气指标及预后的影响[J].临床医学研究与实践,2016,1(23):9-10.
[9]林建良,郑辉才.无创正压机械通气辅助治疗重症肺炎合并呼吸衰竭效果分析[J].医学综述,2016,22(3):606-608.
[10]焦淑芳.经鼻持续气道正压通气治疗小儿重症肺炎合并呼吸衰竭的临床疗效及预后观察[J].中国妇幼保健,2014,29(13):2117-2118.
[10]de Prost N,Mekontso-Dessap A,Valeyrie-Allanore L,et al.Acute respiratory failure in patients with toxic epidermal necrolysis:clinical features and factors associated with mechanical ventilation[J].Crit Care Med,2014,42(1):118-128.
[11]Smith M A,Hibino M,Falcione B A,et al.Immunosuppressive aspects of analgesics and sedatives used in mechanically ventilated patients:an underappreciated risk factor for the development of ventilator-associated pneumonia in critically ill patients[J].Ann Pharmacother,2014,48(1):77-85.
[12]Camporota L,Nicoletti E,Malafronte M,et al.International survey on the management of mechanical ventilation during ECMO in adults with severe respiratory failure[J].Minerva Anestesiol,2015,81(11):1170-1183.
[13]钟小东,陈学清,王晨,等.右美托咪啶联合舒芬太尼在ICU慢性阻塞性肺疾病急性加重期患者有创机械通气中的应用[J].中华全科医学,2015,13(5):766-768.
[14]黎祖荣,聂静,董静,等.咪达唑仑联合舒芬太尼在呼吸衰竭机械通气患者中的应用[J].现代医药卫生,2013,29(6):836-837.
[15]吴捷,张建凤,封海彬,等.芬太尼、舒芬太尼、瑞芬太尼联合右美托咪定在机械通气患者中应用的比较[J].医学理论与实践,2013,26(22):2948-2950.
[16]谭明华,黄燕.舒芬太尼联合右美托咪定在ICU机械通气患者中的临床应用价值[J/OL].中国医学前沿杂志(电子版),2016,8(1):69-72.